In Massachusetts, an injured worker may receive workers’ compensation benefits for a work-related injury provided that all of the eligibility criteria are met. One of the requirements to receive benefits is that the injury must have occurred while the employee was working “in the scope of his or her employment.” Imagine the following scenarios:
Which of these injuries was sustained while the employee was “in the scope of employment?” Which ones are ultimately compensable as a workers’ compensation claim? The answers to those questions are not simple.
In Massachusetts, workers’ compensation claims are handled through the Department of Industrial Accidents. When a worker is injured, the employer typically files a Form 101 “Employer’s First Report of Injury or Illness” to initiate the claims process. The workers’ compensation insurance carrier then has 14 days to evaluate the claim and decide whether to approve and pay the claim. One reason an insurance carrier might deny coverage is because it contends that the injury was sustained while the worker was outside the “scope of employment” at the time of the injury. Analyzing whether an employee was within his or her scope of employment must be done on a case-by-case basis; however, some factors will typically be taken into account when determining whether an employee was within his or her scope of employment when an injury occurred. Answering the following questions may help:
No single question can answer the “scope of employment” question in every case. As with many workers’ compensation issues, each injury must be analyzed individually to determine whether it qualifies for workers’ compensation benefits.
If an employer, or insurance carrier, denies an application for workers’ compensation benefits based on a claim that the worker was not within the scope of employment at the time of the incident, then the worker has the right to appeal the denial.
Contact a Massachusetts Workers’ Compensation AttorneyIf you have been injured in a Massachusetts workplace and your claim for workers’ compensation benefits has been denied because the insurer contends that you were outside your scope of employment (or for any other reason), we may be able to help. The Massachusetts workplace injury lawyers at Kantrovitz & Associates, P.C., are available to review your claim and help you decide what your next move should be. If you would like to know what legal options you have for a work-related injury, we can be reached by calling 800-367-0871 or by using our online contact form.